Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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May 21, 2015
Petrous Internal Carotid Artery Aneurysm
- Petrous internal carotid artery (ICA) aneurysms are uncommon.
- Clinical Presentation: Tinnitus, headache, and occasionally, hearing loss
- Key Imaging Features:
- MR imaging features demonstrate a ovoid enhancing lesion in the petrous pyramid.
- CT scan demonstrates an expansile lesion that cannot be distinguished separately from the horizontal petrous ICA.
- Peripheral calcification when associated with the lesion can help suggest the diagnosis.
- MR angiogram, CT angiogram, DSA can be diagnostic.
- DDx:
- Cholesterol granuloma
- Schwannoma
- Meningioma
- Paraganglioma
- Metastasis
- Lymphoma
- Leukemia
- Rx: Endovascular coiling, flow diversion, parent vessel occlusion (endovascular or surgical). Surgical clipping of the aneurysm is technically challenging due to the location of the lesion.